I posted this one on my facebook a while back after the Sinai fire tragedy. And after the outcry over the MPigs’ decision to lower their education requirements, it all just came back to me. It’s MY vote, MY decision; whether they go ahead with that amendment or not, it’s MY choice whether or not to elect someone without a degree to represent me. It starts with ME. It’s time I took responsibility for my choices.

Sinai: The “tragedy” of Kenyans.

Looking at my wall today,I am reminded of this photo that was doing the rounds on facebook sometime back. It was a chart that was supposed to be a representation of facebook wall activity-minimal on an ordinary day and a HUGE spike on one’s birthday. But whoever came up with it must not have been a Kenyan. Why,you ask? Because had they been Kenyan, they would have added another spike for national “disasters”. Seems to me whenever some calamity befalls Kenyans,it’s all we can talk about for days on end.

Now before you brand me cynical or insensitive,take a moment and just think about recent events. Kenyans for Kenya, Sinai fire disaster;and today im told 12 people have died in Nyahururu after taking some illicit brew.Will Kenyans never learn?? Drought in north Eastern is nothing new;it happens every year. And as for the fire, NTV and Daily nation ran the story of encroachment on the pipeline 3 years back. Don’t even get me started on the number of times we have heard of people dying from illicit brews.

A lot has been said about the amazing way in which Kenyans responded to fellow Kenyans’ starvation. And while I am proud to have contributed in my own small way,what saddens me is knowing that this will be nothing but another knee jerk response;a stop gap measure if you will-until next year when the same thing will happen yet again. Today, it’s all about donations-blood,blankets,medical supplies. Tomorrow, it’s the government paying for the funerals with taxpayers’ money. But we never really stop and think about what we are doing.

Whenever something like this happens, we are quick to anger, even quicker to point fingers at each other. Barely 2 hours in, the blame game had already begun. Why did KPC not have any safety measures? Why did the law enforcement not remove these people from their illegal dwelling? Why didn’t their MP get them to settle elsewhere? Why were they siphoning fuel? Who lit the fire? Why did the fire truck take so long to get there? And of course, the usual-“Tunaomba serikali isaidie”. Why,why,why indeed?

Time and again, I have always said the biggest tragedy facing Kenyans is the fact that we are all just too complacent. We wait until disaster strikes to react yet we all saw it coming. Sure,someone slept on the job and lots of Kenyans paid for it with their lives. But what we need to understand is the real root of the problem. Instead of asking what someone else could/should have done, ask yourself how you have contributed to the problem.

Why do these people continue to live in a place where they surely must have known they were trespassing? Because someone went ahead and built those shanties. They don’t live rent-free! Most,if not all of us will say they don’t know anyone living in a slum. But how about “I know a guy who knows a guy who owns some shanties in the slums” Sounds familiar?

Some of us will say, maybe they died out of their own folly..”Who didn’t hear about those folks in Sachangwan? Didnt they know better than to siphon fuel from the pipeline?” But for every “idiot” who siphons fuel, there is an even bigger one who buys it.

Or perhaps, they live there because they can’t afford to live anywhere else. But who employs these people? “How can the government force me to pay my mboch 7k??!!” A little closer to home now?

My pet peeve has always been the MPigs and their total lack of sensitivity towards their constituents. Every other time they are increasing their salaries while the common mwananchi continues to languish in abject poverty. Yet when tragedy befalls “their people” they are first in line when it comes to dishing out the blame. Publicity stunts,we call them. “Why didn’t they create policies that could have prevented these issues?” Others call them “elitist”,only in it to protect their own selfish interests. But then they don’t elect themselves to parliament,we do! “Come 2012,we will show them!” How many times have we said that,only for the politicians to do their usual musical chairs;change political parties,dance to a different tune and yup,you guessed it…we re-elect them! Getting a little personal now,huh?

I have tagged you for one of many reasons-could be that I thought you may find this a twisted point of view, or because your status/comment provoked me to write this. But most of all, I tag you because I am trying to do what our leaders have failed to do-get you to think critically about creating a better kenya for our future generations. I’m really sick and tired of this deja vu,aren’t you?

So,next time you want to “help” a Kenyan in trouble, help them in the best way you possibly can-by becoming the change we all want to see.

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Birthdays mean different things to different people. For a baby, every year brings with it new milestones-walking, talking, kindergarten. For an older child, it is a time to enjoy attention and presents from relatives. But as we get older, we start to appreciate that each birthday brings with it the hindsight and wisdom that only age can. Personally, I think of birthdays as a time to reflect-to take stock of my achievements and set new goals and targets.

This year, I find the same question has been on my mind time and again: If I died today, what would they say about me? Pretty morbid talk on a day that’s supposed to be joyous, one may think. Suffice it to say I’ve had reason to ponder about this morbid talk on several occasions recently.

As doctors, many of us find it very difficult to strike a good work-life balance. We’re constantly rushing from one thing to the next. A friend the other day lamented how she was robbed of her “childhood” in reference to her undergraduate college years. You see, we’re always too busy to party like everyone else. After which it’s internship-the endless calls and sleepless nights I certainly don’t need to elaborate about. Next, you start working and imagine you have finally “arrived”.

But ALAS! You soon move on to endless locums, ever chasing that elusive shilling. “I’m saving up to go back to school” is the standard excuse. After which it’s back to sleepless nights and calls all over again, struggling to make ends meet while attempting to finish your course-which hardly ever happens on time. And then, it’s time to start building your practice and once you do, the patients never stop calling no matter what time of day or night!

One of my biggest fears is that one day I will wake up and realise I’ve spent so much time on my career that I don’t know my children at all. See, we always forget that even when we’re wrapped up in our own issues, life still continues around us. At first it doesn’t seem like a big deal- “My brother will understand I missed my nephew’s birthday party for a good reason. After all, he’s only 1 year old..” Or, ” It’s been a long week; I’m just too tired to meet up with the girls today.” No big deal, right?

Next thing you know, you have missed so many events you even lost count. And then, a ” big deal” happens and you’re left wondering why nobody bothered to call you and let you know. You just don’t understand how a friend you considered to be close could have undergone major surgery without calling you for advice. Or perhaps lost a relative and you didn’t know it until you came across the announcement in the papers. The guilt, oh, the guilt; and of course the self-reproach we have all had to deal with at one time or the other.. “Where have I been? How did I get here? What can I do now?”

“Don’t work. Be hated. Love someone.” I read that speech sometime back and I remember feeling at the time as though Adrian Tan had me in mind when he wrote it. The long and short of it was, life never quite turns out the way we plan it. So instead of wasting yours on things that don’t matter, live it. Don’t kid yourself- there is someone out there who can do your job just as well, if not better. And when you’re gone, guess what-they WILL find a replacement. After a while, it’s like you were never even there.

See, nobody even remembers that stuff. I mean, have you ever been to a memorial service where anyone spoke about how hard the departed used to work? Or how rich he was? How much property he had amassed? No? Me neither. We all want to be remembered as “a good mother, a loving husband, a dear friend who was always there; a charitable soul who was always willing to lend a helping hand”. So why do we spend so much time doing everything else except that?

What is it that you consider irreplaceable in your life? Is it your family, your friends, a hobby or pastime? Whatever it is, you need to find it, and find it NOW. Put in some more time and effort if it really matters to you. For the world spins madly on. After all is said and done, If you died today, what would you have them say about you?

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Love it or hate it, social media is here to stay. Let’s admit it, it has its uses far beyond catching up with old high school friends. Hypothetical situation: You’ve been busy the last couple of weeks, or maybe out of town. You get back and the office is abuzz with news of something you have absolutely no clue about! No need to worry; there’s always “tweavesdropping” or “facebook stalking”. You know what i mean 😉 A few mouse clicks later, you are not only caught up but are likely to have become an expert on the topic at hand after reading through several conversations/threads.

So the other day, I happened to stumble upon(pun intended) a thread on a friend’s update about doctors’ pay. Apparently, some people were annoyed that doctors seem to have a sense of entitlement which they felt was undeserving. “I’m also struggling to pay my bills despite the rising cost of living but I’m not holding my employer at ransom to increase my pay!” “I earn peanuts but I supplement my income with some business on the side” “If doctors think they aren’t being paid well enough they should find other jobs that pay better” “Doctors just don’t know how to manage their income” just a few of the comments that were made.

I am not one to shy away from an intellectual debate, but I have to say I was hard pressed to defend my position against some of these arguments. And that’s not just because I am not employed in public service. I have to agree that there are many reasons why an employer would increase one’s pay, but entitlement is certainly not one of them. I personally got a rude shock the other day when an employee asked to have her pay increased “because doctors’ pay was also increased”. And I thought, Really???

Once I got over my initial annoyance and disbelief, I realised that I could actually draw many parallels to the doctors’ situation. Which is when I really got to thinking, why do doctors deserve a 300% pay hike? What determines how much one should be paid? I don’t pretend to be an authority on Human resource management, but thank God for the internet!

I came across quite a few reasons but let me just point out the relevant ones in no particular order:

1. Demand and supply of labour. Kenya has a total of 2300 doctors in public service; that’s a ratio of roughly 1:17,500. High demand, low supply.

2. Skills level of an employee. Correct me if I’m wrong, but someone who undergoes over 5 years of intense training plus an additional year of mandatory internship during which (s)he works 24 hours a day, 7 days a week sort of qualifies as highly skilled.

3. “Going rate”: This one’s a killer- Kenyan doctors earn less than 20% of their regional counterparts.

4. Cost of living: Need I say more??

5. Job evaluation and performance appraisal: I’m yet to see this being done objectively so no comment.

6. Geographic location: A large number of civil servants including doctors have to work in remote areas, often away from their families and loved ones. Let’s not even get started on the lack of amenities in these areas.

7. Working hours: I still don’t understand why it is that when a clerk works on a weekend they get paid overtime, but when it’s a medic suddenly people feel the need to invoke the Hippocratic oath?? We are only human after all; we too need rest in order to function.

Employee motivation is closely linked to their job satisfaction and I daresay remuneration is a large part of it. As a country, we have failed miserably in achieving job satisfaction in the medical sector. Doctors are leaving in droves either to work in the private sector or moving to other countries altogether. During the last doctors’ strike, there were 3000 doctors in public service,even more than we have now. This despite the fact that our population has increased; and despite the introduction of the university parallel programme that was set up to try to increase our numbers. So now, we have fewer doctors serving more people who are now more aware of their health; more clinics and dispensaries being set up by CDF kitties all over the place. End result: The few doctors we have are now being stretched even further; which obviously means their productivity is anything but desirable.

So next time you have to visit the hospital in the middle of the night and you wonder why the doctor looks so tired; bear in mind this person has probably been working for 48 hours straight, if not more. Be thankful that they are there at all; those of us who left for “greener pastures” aren’t proud of that fact. So instead of yelling at the poor guy who’s trying to help you, try to be just a little bit more patient and understanding.

We can only hope for the powers that be to realise that if healthcare in Kenya is going to change, we need those 2300 to remain in public service. Better pay, better results.

Hmmm…the more I think about it, the more I start to wonder if 300% is even close!

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Whenever a patient dies, the law requires the attending health worker to fill in a cause of death. Sometimes, it’s pretty straightforward but often we find ourselves in a situation where you have to “certify” a patient you know full well should not have died the way they did. Today, I wanna tell their story; their voices, too, must be heard.

Road Trip

One year ago today, a tragic road trip cut short the lives of two best friends. They had purposed to visit Lake Bogoria but were involved in an accident along the Naivasha-Nakuru highway. One died on the spot while the other sustained a bleed in his brain and was rushed by good Samaritans to the nearby Naivasha District Hospital. He needed emergency surgery to relieve the pressure on his brain, failing which he would certainly die. The attending doctor quickly prepared him for the operation and duly informed the theater staff. However, he was told, there was another patient already in theater with a similar injury so he would have to wait for there was only one set of instruments available in the hospital.

A couple of hours later, he finally made it into theater. By this time, he was already in coma and was barely hanging onto life. Following surgery, he was too weak and remained unconscious. Having no ICU facility in the hospital, the surgeon recommended transfer to another center, the nearest options being either Kijabe or Nairobi. Transferring a patient in his condition was no simple task; he required an ambulance with life support equipment so the hospital’s ambulance would not do. Several calls were placed to get one to drive the 30 or so kilometres from Kijabe; by the time it arrived, the young man was no more.

Cause of Death: Severe head injury

The truth: He died because of lack of surgical instruments, he died because there was no ICU ventilator machine, he died because there was no ambulance.

The Young Mother

She was recently married, and was overjoyed when she discovered she would be “sick” for the following 9 months. She tried her best to eat well through the pregnancy, in spite of the constant nausea. She faithfully attended all her clinics and followed the doctor’s instructions to the letter. When the time came for her to deliver, she checked herself into the nearby sub-district hospital to begin her journey into motherhood.

She had a difficult labour, but finally the baby came- a beautiful, bouncing baby girl. Unfortunately,some complications arose in the period immediately following the birth-she wouldn’t stop bleeding (PPH in medspeak). Despite all the medications the doctor prescribed, the bleeding just wouldn’t stop. She had to be taken in for surgery to take out part of her uterus to control the bleeding. The surgery was successful, but she had lost so much blood. Her blood group was at the time unavailable and the hospital administration had to call the regional blood transfusion centre to request for some. The ambulance that would either have taken her to the provincial hospital or gone to collect the blood had just left to transport another patient. She died waiting for a blood transfusion, her newborn child would never know the joy of feeding from her mother’s breast.

Cause of death: Postpartum haemorrhage (PPH)

The truth: She died because of poor policy, she died because blood transfusion services have not been decentralised.

The Medical Officer

Having just completed his internship, he had his whole life ahead of him. He decided to take a break from his workstation in Busia to visit his parents in Kiambu. They had made a lot of sacrifices to get him to this point, it was only natural that he would want to share this news with them. While at home, he fell sick and was diagnosed with malaria at the Kiambu district hospital. A few days later, he developed kidney failure as a complication of the malaria. He needed urgent dialysis; unfortunately these services were not available there and he was immediately referred to the Kenyatta national hospital.

On admission at the KNH, he was immediately put on the wait-list for a dialysis machine. The list was so long, but he had no other choice as he couldn’t afford to be admitted in a private hospital. His medical cover was a measly 1740 Ksh, not even enough to cover the consultation fee at that private facility. He never made it to the top of the list, his kidneys were too far gone.

Cause of death: Acute kidney injury secondary to severe malaria

The truth: He died because the KNH dialysis unit is overstretched, he died because of inadequate resources.

There are so many more stories to tell; only I can’t squeeze them all into this little space. To the friends and families, I say: Kenyan doctors have not forgotten them, their memories will always stay with us. Their memories are what inspire us to want to do better. It is because of these stories that the blue revolution began.

We should always strive to finish what we started; it is my prayer that the blues will not relent until this, too, is done. Here’s to the new year, and a future where doctors will not certify patients because of the shortcomings of the system.

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“No matter who you are, or what your circumstances may be, you are special, and you still have something unique to offer. Your life, because of who you are, has meaning.” -Barbara de Angelis.

The other day, a friend invited me to speak about my favourite children’s book at a charity event. After giving it some thought, “Charlotte’s Web” by E.B White was my obvious choice. Not just because I loved it so much, but also because I learnt some valuable life lessons from it; even though I didn’t realise it then.

Charlotte’s web is about the unlikely friendship between a pig and a spider. Wilbur the pig was born a runt, the smallest of his litter. To the farmer who owned him, he was worth close to nothing and he therefore saw it fit to put him to “sleep”. By a stroke of luck, the farmer’s daughter came across this information and begged her father to let the piglet live. Eventually Wilbur ended up living on her uncle’s farm in a barn with several animals, one of whom was Charlotte the spider.

His new owner plans to have Wilbur for Christmas dinner; and he shares this concern with his new friend Charlotte, who promises to find a way of saving his life. Wilbur is surprised by this, for he cannot comprehend why anyone would want to save a worthless runt. He is amazed by this wonderful creature and says to her, “Charlotte, you are beautiful”. To which she replies, (my favourite quote :-)) “No, I am not beautiful; I am nothing, but I will have to do.” This line has stayed with me for years and years; and recent events have brought it back to me again.

I like to think it was no coincidence that the author chose a brown spider, pretty small and harmless by human standards to play lead role. During the doctors’ strike, everyone kept asking why all the doctors they saw looked so young. It was mostly because the few doctors remaining in public service are those who have recently qualified. But that to me is besides the point. I believe the youth are the future, and it is commendable that these youth chose to do something about the status quo.

We always complain about things we think are wrong, and claim not to have the means to do something about it. But I believe if we put our minds to it, we can and we will. Let’s borrow a leaf from this little brown spider.

“I am nothing; I may be young, I may not be rich, I may not be powerful, but I can do something.”

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I posted this on my facebook wall sometime back and thought I should share:

What is the value of Ksh 400,000?
1. One chair (yes,one!) in the proposed new parliament-for them to sleep more comfortably perhaps?
2. 10 months’ salary for an intern doctor in a public hospital
3. One good quality ECG machine for rapid diagnosis of a heart attack ; 20% of the cost of an ICU life support machine
4. Two years’ worth of tuition fees for a masters’ student in medical school
5. Medical allowance of 230 doctors for one month (currently a paltry 1740 Ksh-not even enough to cover consultation at Nairobi hospital!)
6. 26 dialysis sessions at a private facility
7. 30% of an MP’s salary
It’s high time our govt got its priorities in order!

Yes, we really need to get our priorities in order. As a doctor, my brain is my biggest asset. I have to have knowledge in order to make the right diagnosis and institute the correct treatment. On the other hand, my knowledge is nothing if I haven’t got the right tools to execute my treatment plan.

So just how bad is it? At the moment, we have only:

2 public hospitals with ICU facilities

4 dialysis centres countrywide

1 medical specialist for every 400,000 people

1 medical officer (GP) for every 18000 people

ECG machines only available in provincial hospitals

Here’s a little more math for you. The cost of an MP’s chair has now come down to 200,000Ksh (and they won’t let us forget how this is such a good deal!) So 200,000 for roughly 300 chairs=60M, enough cash to cater for:

1. 27 life support machines; to have at least 4 in every provincial hospital

2. 150 ECG machines; to have at least 1 in every district/ sub-district hospital

3. Tuition fees for the full masters’ programme for 100 students which would go along way in reducing the shortage

4. 100 dialysis machines

I could go on and on…I just wonder: Do the powers that be care more about our MPs’ backsides than they do about our health? Kuweni serious!